The rising tide of dementia in Canada: Facing the critical challenge by 2025

On September 17, 2015, Drs. Carole Estabrooks and Howard Feldman convened the 10th Annual Forum of the Canadian Academy of Health Sciences (CAHS) on the topic of dementia in Canada. The Academy is a unique Canadian organization that brings together a breadth of expertise and scholarship across a broad view of health, including social scientists, biomedical researchers, health care practitioners, and technology experts. Fora and their follow-up activities often produce important outputs including publications that can serve to inform public policy.

This Forum addressed the many dimensions of how the unprecedented growth of dementia in Canada will reshape our landscape, socially, economically, medically and politically. The particular focus of this event, was to capture the broad view of how we will need to advance systems of care delivery, re-shape our living and built environment, mobilize technology, and develop an end-to-end national program so that all Canadians with Alzheimer’s disease or other forms of dementia can receive quality care and be supported in their communities, irrespective of where they live, or who they are.

The magnitude of the dementia challenge was underscored both from Canadian data where it is projected that there will be close to 800,000 individuals affected by 2031, and from global estimates where the prevalence is projected to more than double to 81 million affected individuals by 2040.

A critical part of the solution, was noted to reside in the potential for disease prevention, where in the same time frame a delay in diagnosis of 1 year could reduce prevalence by 10% while a 5 year delay could half the prevalence. Clinical trials data were presented underscoring that a combination approach of exercise training, cognitive training, control of vascular risk factors, and dietary counselling created significant benefits in cognition and well-being, setting the stage for pursuit of such benefits in larger and longer studies and programs.

There were presentations on some superbly innovative programs of care, and technologies being developed in Canada that hold the potential to transform care, as well as, presentations highlighting the significant challenges we face in providing quality care, quality of late life, and quality end-of-life care to affected persons in the middle and advanced stages of dementia. Within the rural setting, researchers in Saskatchewan and Quebec have come up with systems of care to better deliver and reach individuals irrespective of where they live. Research investments in technology will allow the mobilization of state of the art engineering solutions to help provide safer home environments for those at risk and allow them to get around their communities.

Additionally efforts to support better understanding of the biology of these disorders were noted to have received significant funding and attention. However, it was also recognized that as a country we need to move from being prolific in pilot projects to being able to scale up and implement programs of proven research benefit to benefit the lives of Canadians across the country.

There was a consensus viewpoint of the Forum attendees at the end of the day that the Academy consider an assessment that would develop evidence-informed recommendations to improve scalability and implementation of programs and interventions for individuals at risk or affected by Alzheimer’s disease and other forms of dementia across the country.

Dr Carole A Estabrooks is Professor, Faculty of Nursing, at the University of Alberta, and Tier 1 Canada Research Chair in Knowledge Translation. She is a fellow in the Canadian Academy of Health Sciences (FCAHS) and in the American Academy of Nursing (FAAN). She is Scientific Director of the Knowledge Utilization Studies Program (KUSP) and the pan-Canadian Translating Research in Elder Care (TREC) research program hosted at the University of Alberta.

Dr Estabrooks’ applied health services research program focuses on knowledge translation in the health sciences. She studies the influence of organizations on the use of knowledge and its effects on quality of care, quality of life/quality of end of life and quality of work life outcomes. Her work is primarily situated in the residential long term care sector and focuses increasingly on quality improvement and the spread and scale-up of innovation.

Dr. Estabrooks is a past member and vice-chair of CIHR’s Institute of Aging Advisory Board. She is appointed in the University of Alberta’s School of Public Health and is affiliated with the University of Toronto’s Nursing Health Services Research Unit. She is a co-investigator on numerous national and international research projects. She is the 2014 recipient of the CIHR Institute of Aging’s Betty Havens prize in Knowledge Translation. She teaches in the doctoral program and supervises graduate students and postdoctoral fellows. She has developed and continues to evaluate the Alberta Context Tool (ACT) currently in use in nine countries and six languages.

Dr. Howard Feldman, MD, FRCP (C)

Professor of Neurology and Director UBC Hospital Clinic for Alzheimer’s Disease and Related Disorders, University of British Columbia, Vancouver.

In his research, Dr. Feldman has made seminal contributions to his field with scientific discoveries and clinical research focussed on aging, mild cognitive impairment/ Alzheimer’s disease, frontotemporal dementia (FTD) and diagnostic/therapeutic trials. His research has contributed to the discoveries of the progranulin (Nature 2006) and C9ORF72 (Neuron 2011) genetic mutations which cause FTD and FTD with motor neuron disease. He has also contributed to the development of important novel criteria for Alzheimer’s disease that conceptualize and operationalize the earliest stages of disease (Lancet Neurology 2007, 2011,2014). He has lead a number of international clinical trials in Alzheimer’s disease contributing important new original data, informing care across the continuum of the disease.

His career contributions have been profiled in Lancet Neurology in 2007, and in 2014 was named by Thomson Reuters as a highly cited neuroscientist and amongst the world’s most influential scientific minds. He has been appointed as Fellow of the Canadian Academy of Health Sciences and the American Academy of Neurology in 2008. He has served as inaugural Fisher Family and Alzheimer Society of British Columbia Endowed Professorship for Research in Alzheimer’s Disease. He currently serves as the Director UBC Hospital Clinic for Alzheimer’s Disease and Related Disorders and works both as an active clinician, educator and research scientist.LA VAGUE CROISSANTE DE LA DÉMENCE AU CANADA : AFFRONTER CE DÉFI CRITIQUE D’ICI 2025